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because you're accountable for the follow-up care of any preexisting skin injury
that's not documented during pre-op assessments.
Make sure the surgical team is aware of skin concerns that were discovered dur-
ing the pre-op assessment and positioning concerns that must be addressed. Nurses
must confirm that needed positioning aids are available before the start of the case.
One additional note about positioning aids: Clean them according to the manufac-
turers' written directions. Using inappropriate cleaning agents can damage their
surfaces and jeopardize the padded protection they were designed to provide. Also,
improperly cleaned positioning aids increase risk of infection, which is another
event CMS will not pay for.
During surgery
Don't assume you don't have to be overly worried about procedures lasting less
than an hour. That's no longer an acceptable approach to patient positioning.
Patients who are not positioned properly can still develop pressure injuries dur-
ing shorter cases, so take the time to focus on proper positioning practices and
make sure you use appropriate padding during each and every case.
When positioning patients, turn off the music, stop unnecessary conversations
and focus on the task at hand. There needs to be a constant staff presence at
the table. Use at least 2 points of restraint during extreme positioning to ensure
the patient doesn't slip off the table. Before applying the prep or drapes, tilt or
place the patient in the required position to ensure positioning aids are in the
right place to protect bony prominences and other areas that will bear the brunt
of the patient's weight. Also confirm that the patient is secured to the table, per-
haps with the help of a footboard and underbody pad that prevents slippage.
Recheck potential pressure points every time the patient is moved or the
table is adjusted. A safety strap that fits safely and snugly around the patient
could become too tight if the table is tilted mid-procedure. Finally, document
the position or positions used during the case and the anatomy that was under
increased pressure.
